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UNITED STATES PUBLIC HEALTH SERVICE 

RUPERT BLUE, Surgeon General 



A REPORT OF THE SANITARY INSPECTION OF 

RURAL SCHOOLS OF EAST TENNESSEE 
AND NORTHERN GEORGIA 



BY 



CHARLES A. BAILEY 

M 

Acting Assistant Surgeo?i 
United States Public Health Service 



REPRINT No. 237 

FROM THE 

PUBLIC HEALTH REPORTS 

December 4, 1914 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1915 






--•Z £>0 2-2_. 



L&3W 

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a'SFG, 
JAN 30 1915 






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SCHOOL HYGIENE. 

A REPORT OF THE SANITARY INSPECTION OF RURAL SCHOOLS OF EAST 
TENNESSEE AND NORTHERN GEORGIA. 1 

By Charles A. Bailey, Acting Assistant Surgeon, United States Public Health Service. 

In compliance with orders of December 1, 1913, from the Surgeon- 
General and in cooperation with the State boards of health of Ten- 
nessee and Georgia, a sanitary inspection of the rural schools of East 
Tennessee and Northern Georgia was undprtaken in conjunction 
with studies of the prevalence of trachoma. 

Extent of Survey. 

The inspections were begun in the schools of Anderson County, 
Tenn., December 8, 1913, and terminated in Hall County, Ga., April 
24, 1914, during which time 122 white schools and 4 colored schools 
were visited in various sections of 31 counties of east Tennessee and 
79 white schools and 5 colored schools were inspected in 25 coun- 
ties in northern Georgia. The inspections were made almost ex- 
clusively in rural schools, where there is practically no sanitary 
supervision in the construction of school houses nor is there any medi- 
cal inspection of the pupils, but from observations made during this 
survey it is quite apparent that such supervision is much needed. In 
many of the cities the sanitary control of school buildings and the 
supervision of the pupils are being maintained, but rural schools on 
the whole have been much neglected. 

Time would not permit of complete physical examination of the 
country school children other than the examination for the preva- 
lence of trachoma, but many defects were observed, such as dental 
caries, adenoids and enlarged tonsils and cervical glands, errors of 
refraction, defective hearing, malnutrition, and heart disease. Most 
of such defects can and should be corrected in early life, as to neglect 
them results in physical impairment of the child's health and ability 
to acquire knowledge. 

School Buildings. 

In east Tennessee 126 schools were visited and inspected ; of these, 
36 were brick and 90 frame buildings. Fourteen, or 11 per cent, 
were one-room buildings; 33, or 26 per cent, were two-room build- 
ings ; 18, or 14 per cent, were three-room buildings ; 12, or 9 per cent, 

1 Reprint from the Public Health Reports, vol. 29, No. 49, Dec. 4, 1914. 
72841°— 15 3 



4 RURAL SCHOOLS EAST TENNESSEE AND NORTHERN GEORGIA. 

were four-room buildings; 16, or 12 per cent, were five-room build- 
ings; and 33, or 26 per cent, were buildings with from 6 to 10 rooms. 
In northern Georgia 84 schools were visited and inspected. Of 
these 18 were brick buildings and 66 were frame structures. Twenty- 
one, or 25 per cent, were one-room schools; 23, or 27 per cent, were 
two-room schools ; 16, or 19 per cent, were three-room schools ; 7, or 
8 per cent, were four-room schools; 3, or 3 per cent, were five-room 
schools; and 14, or 16 per cent, were schools having from 6 to 10 

rooms. 

Area and Condition of School Yards. 

The yards of rural schools vary in size from one-third of an acre 
to 5 acres. Many of them are well graded and clean, while others 
are much neglected, with rubbish and debris lying about. In other 
instances grounds are densely wooded, preventing the free entrance 
of air and sunshine to the schoolrooms as well as making them dark. 

Drainage. 

Most of the school yards were well drained, either by the nature 
of the soil or by the contour of the surface. Many of the yards are 
gravel and drain quickly, while others are of clay and during rainy 
days are very muddy. In only a few instances were paved or 
gravel walks provided from the road or street to the school or from 
the school building to the outhouses, so that much dirt was carried 
into the schoolroom on the boots of the children. The largest num- 
ber of schools visited in east Tennessee were situated on elevated 
land. Many of them were on ground poorly adapted for the pur- 
pose because of its elevation and abrupt slope. In Tennessee the 
yards of 100 schools had good drainage, while 26 had poor drain- 
age. In Georgia the grounds of 68 had good and 16 had poor 
drainage. In a few instances surface outhouses were situated at 
higher elevations than the wells, and the surface drainage was 
directly toward them. 

Outhouses. 

Among the most flagrant breaches of sanitation at rural schools 
are the outhouse and the disposal of excreta. Surface soil pollu- 
tion is going on everywhere, and that too, in sections where hook- 
worm, for instance, is most prevalent. The vast majority of out- 
houses are set on top of the ground, and are dilapidated and open 
at the back, allowing free access of flies and animals. A school prin- 
cipal remarked to me one day, " We do not have to dispose of ex- 
creta here — the hogs are our scavengers." In many instances the 
outhouses were found filthy and insanitary, being filled with excreta 
almost to the seat. The seats and floors were urine-soaked, and the 
odors emanating made it practically impossible to remain in the 



RURAL SCHOOLS EAST TENNESSEE AND NORTHERN GEORGIA. 5 

house, let alone occupying a seat. In consequence the floor was often 
used. In a few instances a urine trough was provided in the boys' 
outhouse, but invariably it was in a bad state of repair or filled with 
rubbish, rendering it absolutely useless and worse than none at all. 
The care of the outhouse, in a vast majority of instances, seems no 
one's duty. At a very small number of places some attempt is oc- 
casionally made at removing the excreta, while in others, lime is 
used. In a few places dirt, brick, or concrete vaults were found 
from which the excreta was removed at regular intervals and either 
cremated or buried. In one such house, built of brick, with a concrete 
vault, oil was poured into the vault once a week and the excreta 
was cremated without removing it. Six sanitary pail privies, in 
good repair were found in the sections visited in the two States. 
Also one other such privy was seen, although it was not provided 
with either bucket or trap door and remained open in the back. 
One school only was equipped with a septic tank. In "one county of 
Tennessee, where the largest number of sanitary brick school build- 
ings were observed, the outhouses at these schools were, in almost 
every instance, insanitary, dilapidated frame structures. Not one 
house was found screened against flies and but a very small number 
were provided with suitable screens in front of them. Many schools 
visited, but found closed at the time of the survey, were not provided 
with outhouses. 

Sources of Water Supply. 

Drinking water was supplied from dug and driven wells and' 
springs, the most common source being the dug well, which as a rule 
is shallow, rarely exceeding 30 feet in depth. Most of the springs 
were unprotected from surface drainage or animal pollution and 
were not fenced off to prevent their use by cattle. While a number 
of the wells were brick or concrete, with concrete covers in good re- 
pair, the large majority of them were loosely covered with boards, 
usually in a bad state of repair and without troughs, allowing refuse 
water to drain freely into the well. 

Kind of Drinking Cup Used. 

The open water pail and tin dipper are still extensively used in the 
rural schools, but the individual drinking cup is finding its way 
into some of the schools of even the remotest country districts. In 
some schools both the common and individual cups were used, it 
being a matter of choice with the pupil whether he drank from the 
dipper supplied with the open bucket or whether he drank from his 
individual cup after drawing the water in the tin dipper supplied 
by the school. In one colored school in Georgia the teacher had 
supplied himself with a glass pitcher and tumbler for his personal 
use, while his pupils used the tin dipper and open water bucket. 



6 KUEAL SCHOOLS EAST TENNESSEE AND NORTHERN GEORGIA. 

At a number of schools the drinking water is drawn or pumped from 
the well, as required for immediate use, in the common or individual 
cup. At one school in each State water was pumped from a driven 
well by a gasoline engine to water barrels situated on the school 
grounds. In both instances the barrels were found unclean and with 
poorly fitting covers, allowing easy access to mosquitoes and bugs. 
In east Tennessee 31 schools used the open water bucket and 8 the 
water cooler. In Georgia 34 open water buckets were found and 18 
water coolers. 

At 100 schools in Tennessee and 83 schools in Georgia where drink- 
ing water is provided for the pupils, the following kinds of drink- 
ing cups are in use : 



Common cup or tin dipper 

Individual cup 

Both common and individual cups 
Sanitary drinking fountains 



Total: 




Lighting and Blackboards. 

In the majority of schools the lighting area is adequate. Very 
frequently, however, too much light is admitted from windows on 
three or four sides. In the newer schools the windows are all located 
on one side of the room, usually to the pupils' left. At one school, 
in Marion County, Tenn., although the windows were located on 
but one side of each room, the desks were so arranged that the light 
came from the back instead of from the pupils' left side. With the 
light admitted from but one side of the room, there can be no cross 
lights, no glare in the face of the pupils, and the proper placing of 
blackboards is simplified. With windows on three or four sides, 
there are many bad cross lights and a sufficient number of black- 
boards can not be properly placed. At several schools the pupils 
were found directly facing the light, causing, undoubtedly, much eye 
strain. Three schools in Georgia had a veranda surrounding the 
building, which made the rooms dark and materially interfered with 
the natural ventilation. Apparently but little consideration has been 
given to the proper placing of blackboards, especially in the con- 
struction of the older rural school buildings, with reference to the 
light reaching them equally, without causing shadows on some parts 
and too great a glare on others. They are frequently placed either 
too high or too low or extend into corners, where the light is always 
bad. Improperly placed blackboards cause much eye strain and 
muscular fatigue. 

The following observations were made as to light and location of 
blackboards : 



RURAL SCHOOLS EAST TENNESSEE AND NORTHERN GEORGIA. 





Tennessee 
schools. 


Georgia 
schools. 


Good light 


50 
66 
10 


35 




25 




24 








126 


84 


Location of blackboards: 

Well placed 


52 

74 


30 




54 






Total 


126 


84 







Materia! and Color of Walls. 

The walls of schoolrooms were plaster or wood, painted, tinted, 
or natural. Many colors, such as green, light grey, brown, and 
blue were seen, but light green predominates and probably is the 
best color that can be used. A few schools had papered walls. 

Heating. 

The largest number of schools are heated by stoves in each room. 
The old-fashioned, plain, coal or logwood stove is used, and that part 
of the room immediately surrounding the stove is much overheated, 
while the rest of the room is likely to be cold. Not one of the patent 
"sanitary heaters" was seen. This* heater is a jacketed stove. 
Fresh air is admitted from outside of the building and conveyed by 
a flue to a jacket surrounding the stove. As the air becomes warmed 
in the jacket it rises and escapes into the room from the top of the 
stove, supplying fresh, warmed air, and a more uniform tempera- 
ture is maintained. This type of stove is far more sanitary than the 
oldfashioned coal stove, and is inexpensive, and practical for 
country schools. Of the Tennessee schools 92 were heated by stoves, 
16 by hot-air furnace, and 18 by steam. In Georgia 72 were heated 
by stoves, 7 by hot-air furnaces, and 5 by steam. At one school 
in Sequatchie County, Tenn., a very vicious hot-air system was 
observed. The air was drawn from the classrooms by one series of 
flues to the furnace, where it was heated and returned by another 
set of pipes to the classroom. 

Ventilation. 

The most common method found, where any attempt at all was 
made to ventilate, was through the open doors and windows. In 
but three or four schools was there overcrowding of the children in 
the rooms. Many of the rooms, however, were overheated and 
poorly ventilated, especially those heated with coal stoves. Many 
rooms were found with closed doors and windows. The moisture of 
the air of the schoolrooms, although so essential to the comfort of 
children, is but seldom supplied. In the two States, out of 164 



8 RURAL SCHOOLS EAST TENNESSEE AND NORTHERN GEORGIA. 

schools heated by coal stoves, but four were found where moisture 
was supplied from water vessels on the stove to the use of rooms. 
Eight schools in Tennessee and three in Georgia were equipped with 
fresh air inlets and foul air outlets in each classroom. At one of 
these latter schools the vents were found stuffed with rags, destroy- 
ing their usefulness. 

Cloakrooms. 

In the majority of schools provision has been made for the hang- 
ing up of outside clothing, wraps, and hats in places other than the 
classroom. Either the hallways are equipped with hooks for this 
purpose, or 1 large room is set aside as a cloakroom. At other 
schools each classroom has a cloakroom immediately adjoining it. 
Of 126 schools visited in Tennessee, 81 were found to be provided 
with cloakrooms, while 45 were unprovided; in Georgia 52 schools 
were provided and 32 made no provision for space for children's 
wraps. 

Facilities for Washing Face and Hands. 

A very small number of schools provide any means for the pupils 
to wash their faces and hands. Of 126 schools in Tennessee, but 
8 had such facilities, in 4 of which schools the common hand towel 
was in use, and in 4 paper towels were provided or individual 
towels were used. In the 84 Georgia schools, but 4 provided means 
for washing, at one of which the common towel was in evidence, and 
3 used paper or individual towels. 

Seats and Desks. 

Many varieties of seats, and desks, both single and double, were 
observed. In a few schools no desks were provided, and the children 
sat on hard wooden benches with straight backs or no backs at 
all. In several schools the old hand-made high desks, with a high, 
straight-back seat, were still in use, and the children occupying them 
looked and undoubtedly were most uncomfortable. Their use should 
be prohibited. Not one school of those examined in either State 
was equipped with adjustable seats. However, most of them were 
provided with seats and desks suitable for the various ages, but a 
number were using seats far too large for the pupils occupying them. 
Each seat and desk should be adjusted according to the size of the 
child to occupy it, and not the child to the desk, to give it an easy, 
unrestrained j>osition and prevent the development of deformities. 

Condition of Classrooms. 

Many of the rural schools do not have a janitor and the rooms are 
swept and cleaned by the teacher and pupils. However, it was not 
always the school without a janitor which was most unclean, as many 
without such service were very clean. Frequently the sweeping is 



EUKAL SCHOOLS— EAST TENNESSEE AND NORTHERN GEORGIA. 9 

done at a most inopportune time, as I had occasion to witness at two 
schools. At one school during a morning recess and at another school 
at the noon hour, with some of the pupils eating luncheon, several 
children were laboriously sweeping the floors. All the windows were 
closed, a hot fire was burning in the stove, and the dust circulating 
was so thick that one could scarcely see across the room. If paved or 
gravel walks were provided and the pupils compelled to clean their 
muddy boots on an inexpensive scraper or mat before entering the 
school building, the rooms would be much cleaner. However, the 
sweeping of schoolrooms should be done only after the children have 
been dismissed for the day and with all the doors and windows open. 
The condition of classrooms was as follows : 





Tennessee 
schools. 


Georgia 
schools. 


Clean 


42 
56 
28 


28 


Fair 


33 


Dirty 








Total 


126 









Summary. 

The sanitary needs of the schools of rural districts are many and 
urgent. In a large number of these schools the buildings, their out- 
houses, grounds, surroundings, or water supply are insanitary, and 
there is a general lack of medical inspection of the children. Sani- 
tary supervision of schools and children has been confined in the past 
entirely to a few of the larger towns and cities, but it should be 
extended to the rural districts, where a much larger number of chil- 
dren live. The 1910 census of Tennessee showed that there were 
then in the State 731,478 children of school age ; that is, between the 
ages of 6 and 20, of whom over 600,000 were residing in rural dis- 
tricts, and that 59 per cent, or approximately 325,000 of them, were 
attending school. About the same conditions prevailed in the rural 
schools visited in northern Georgia. 

Many of the insanitary conditions found are due, in a measure, 
to insufficient funds, but very often to indifference and the absence 
of scientific advice or lack of knowledge of the laws of hygiene. 
Many schools are not provided with outhouses at all. When a water- 
carriage system is not available the privies should be constructed as 
sanitary pail closets, of some nondestructible material, as brick or 
concrete, and should be screened against flies and regularly cared for. 

There is need for extensive studies of the sanitary condition of 
these schools and a systematic campaign of education of rural com- 
munities, by means of illustrated talks to school children and others 
on personal hygiene and public health. Also the economy of school 
hygiene should be demonstrated to county courts and others in charge 



10 RURAL SCHOOLS EAST TENNESSEE AND NORTHERN GEORGIA. 

of educational matters. The absence of children from school be- 
cause of sickness, most of which is preventable and due to lack of 
sanitation, is an economic loss to a community, as well as a serious 
loss to the child, whose opportunity to acquire an education is limited 
usually to five months each year. 

The heating, lighting, and ventilation of school rooms are subjects 
also for much consideration, as well as the water supplied to the pupils. 

There is much need also for a systematic and regular medical 
inspection of these schools and pupils, as many curable communicable 
diseases, notably trachoma, were observed. Many children were seen 
with errors of refraction, enlarged tonsils and adenoids, dental caries, 
and other physical defects, most of which are amenable to early treat- 
ment, but to neglect which will cause needless suffering and hardship 
later in life. 

In both States there has been considerable educational advance- 
ment and improvement in rural schools in the last few years. Tho 
consolidation of many of the one and two room schoolhouses into 
one central school is providing for a longer term, with much better 
educational facilities and a far more sanitary school. Through the 
efficient work of the State superintendents of public instruction, 
especially that of Prof. S. H. Thompson, of Tennessee, many of these 
consolidated schools have been formed and much interest in educa- 
tional matters and sanitation has been created. 

During the decade 1900-1910 illiteracy had decreased in the 
aggregate about 6 per cent in the 31 counties visited in east Ten- 
nessee. This improvement will undoubtedly continue, and with 
increased knowledge we may expect better sanitary conditions and a 
keener appreciation of the efforts being made to prevent sickness and 
to prolong life. 

The study of the sanitary condition of rural schools, the correction 
of the insanitary conditions which now prevail, and the medical 
inspection and supervision of school children will be of the greatest 
value not only to the individual but to the State and Nation as well. 
It will prevent the spread of the communicable diseases of childhood 
and ultimately aid in the eradication of these diseases as well as 
remedying physical defects which may interfere with the intellectual 
progress of the children concerned. 



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